ra*Tfu 

JYWL-  miss. 

I / i \ 

Baby  and  Mother  Welfare 
Work  in  India 


By 

MARY  RIGGS  NOBLE,  M.  D. 

Christian  Women’s  Medical  College 
Ludhiana,  Punjab,  India 


A revision  of  the  leaflet,  “The  Mission  Station  as  a 
Social  Settlement,”  by  the  author. 


The  Woman’s  Foreign  Missionary  Society 
of  the  Presbyterian  Church 
501  Witherspoon  Building 
Philadelphia 


From  the  Women  of  the  East  to  the  Women 
of  the  West 


O women  of  the  West  that  hear  not, 

O women  dwelling  in  the  blessed  light, 

O women  of  the  West  that  fear  not 

The  darkness  deepening  into  endless  night: 

By  lives  that  end  when  yours  are  just  beginning, 
By  babes  that  perish  in  our  helpless  hands, 

By  mother  joys  we  have  no  hope  of  winning. 

By  nameless  horrors  which  our  law  commands. 

By  hands  stretched  out  unto  the  god  that  heard  not, 
By  prayers  that  never  rose  above  the  earth, 

By  eyes  uplifted  to  the  skies  that  stirred  not, 

By  hope  that  perished  in  convulsive  birth — 

O women,  dowered  with  wealth  of  love  and  power, 
’Tis  thus  we  call  you,  ’tis  no  fancied  need. 

By  lives  that  perish — hundreds  every  hour — 

In  name  of  Him  who  died,  O come  with  speed! 

— Selected. 


Baby  and  Mother  WelfareWork 
in  India 


BY  MARY  RIGGS  NOBLE,  M.  D. 


DNDIA  may  be  lagging  seriously  behind, 
so  far,  in  widespread  welfare  move- 
ments, as  they  are  conceived  in 
America,  yet  some  of  the  most  telling 
beginnings  have  been  made  by  Mis- 
sion Hospitals  in  life-saving  efforts,  in  addition 
to  the  regular  work  of  healing  the  sick.  In- 
fant mortality  and  the  puerperal  death-rate 
are  appallingly  high.  No  statistics  are  avail- 
able, but  a recent  estimate  placed  the  baby 
death-rate  at  fifty  per  cent.  Infanticide  is 
widely  practiced  still,  because  of  the  undesired 
girl-baby  and  the  poverty  that  is  a sound  argu- 
ment against  having  an  extra  mouth  to  fill. 

The  account  of  our  starting  mid-wifery 
training  among  the  Dhais  (hereditary  mid- 
wives) in  Ludhiana  shows  how  persistence 
and  determination  won  us  a long-desired  in- 
fluence among  those  in  whose  unclean  and 
skilless  hands  lay  the  fate  of  so  many  mothers 
and  babies. 

Ever  since  the  opening  of  our  Hospital 
there,  it  had  been  the  desire  of  those  who 
have  the  welfare  of  mother  and  child  at  heart 


3 


to  train  these  so-called  “mid-wives,”  whose 
ignorance  is  so  crass,  and  whose  practices  are 
so  appalling,  and  at  whose  door  lies  the  respon- 
sibility, therefore,  for  hundreds  of  deaths 
every  year.  And  what  is  true  of  our  one  city 
is  true  of  all  India. 

The  “Indigenous  Dhai”  is  a horror ! In 
Ludhiana  we  had  made  attempt  after  attempt 
to  lure  her  into  our  midwifery  classes,  to  teach 
her  the  necessity  of  cleanliness  and  a few 
Western  methods.  This  trade  is  passed  down 
from  mother-in-law  to  daughter-in-law  for 
generations  back.  As  very  young  women  they 
had  begun  to  act  as  wid-wives,  and  they  per- 
sistently spurned  any  suggestion  of  ours  that 
they  should  learn  better  ways.  It  is  held  that 
babies  and  mothers  perish  because  fate  decrees 
it,  not  because  of  anything  they  do  or  omit  to 
do.  If  fate  determines  their  survival,  why 
learn  a better  method?  Talking  and  agitation 
and  persuasion  were  of  no  use.  Even  the 
Deputy  Commissioner  was  asked  if  he  could 
not  co-operate,  and  compel  the  women  to  come 
and  learn.  He  would  gladly  have  done  so,  but 
felt  that  it  was  not  his  place  to  step  in.  Al- 
most as  a last  resort,  it  was  decided  that  some 
of  the  prominent  men  of  the  city  should  be 
■interviewed,  and  told  that  their  wives  and 
daughters  need  not  run  such  risks.  But  it 
was  “custom,”  and  they  could  not  ask  their 
families  to  change  or  suggest  the  mid-wives 
breaking  over  this  everlasting  barrier. 


4 


Yearly  the  Inspector-General  of  Civil  Hos- 
pitals asked  if  we  had  got  hold  of  any  of  these 
women.  We  had  others  in  our  classes,  Mo- 
hammedan and  Christian  women,  learning 
modern  midwifery.  The  Inspector  finally 
asked  us  if  it  would  be  a feasible  thing  to  try 
and  hire  the  women  to  come  and  learn.  Lady 
Curzon  had  been  extremely  interested  in 
raising  a fund  to  promote  the  training  of 
Dhais,  and  the  Inspector  suggested  the 
possibility  of  our  being  able  to  get  a grant 
from  this  fund.  Following  this  plan,  a short 
three  months’  course  was  outlined,  and  with 
the  financial  petition  attached,  was  sent  up  to 
Government.  Our  own  institution  had  not 
money  enough  to  finance  such  a scheme,  even 
though  it  would  not  take  much,  for  we  are 
very  much  in  the  fashion — we  are  poor. 

It  took  six  months  for  the  papers  to  pass 
through  the  proper  channels,  and  when  at  last 
we  had  word  that  the  approval  and  sanction 
of  Government  was  about  to  be  bestowed,  it 
was  just  as  the  thermometer  was  getting 
highest,  when  our  supply  of  physical  strength 
was  getting  lowest,  and  the  staff  short  in 
numbers.  However,  we  could  not  wait.  We 
went  down  first  to  the  quarter  of  the  city 
where  the  mid-wives  live,  to  have  a talk  with 
them,  and  we  found,  to  our  surprise,  a fair 
number  of  bright-looking  young  women.  We 
somehow  had  the  feeling  that  old  women 
would  be  all  that  we  could  hope  to  get  hold 


of  at  first,  anyway.  Oftentimes  when  we  were 
called  to  cases,  as  a last  resort,  the  baby  per- 
haps dead,  and  the  mother  dying,  it  was 
almost  invariably  a poor  old  woman  who  sat 
at  the  head  of  the  bed  sulking  because  we 
had  been  summoned.  I have  felt  that  it  was 
probably  because  the  younger  ones  were  smart 
enough  to  run  away  before  we  got  there;  but 
angry  though  the  old  ones  were,  they  would 
sit  tight.  Going  down  for  our  first  interview, 
there  were  both  young  and  old  ready  to  listen, 
because  we  could  mention  the  name  of  Gov- 
ernment and  because  we  could  say  “money.” 
They  were  to  be  paid  for  each  lesson,  were 
to  have  an  additional  money  prize  at  the  end 
if  they  passed  the  simple  examination  to  be 
given  by  the  Civil  Surgeon,  besides  the  certi- 
ficate signed  by  Government  after  the  surgeon 
passed  them.  All  this  seemed  to  be  very 
tempting  bait ! They  were  inclined  to  consider 
coming  to  the  class,  but  they  averred  they 
could  not  possibly  think  of  coming  up  to  the 
Hospital ; it  was  too  far.  And  further,  they 
could  not  have  the  class  in  the  cooler  parts 
of  the  day — they  were  apt  to  be  busy  with  their 
cases  then.  When  the  thermometer  is  stand- 
ing at  uo°  to  120°  in  the  shade,  three  o’clock 
in  the  afternoon  in  India  is  not  conducive 
to  real  personal  comfort  apart  from  a pankah. 
However,  since  that  was  the  hour  they  chose, 
heat  and  a little  mud  room  must  not  interfere 
with  this  first  venture. 


6 


After  several  interviews  and  much  discus- 
sion, everything  looked  ready  and  the  day  was 
set,  and  as  a last  reminder  the  orderly  was 
sent  around  the  night  before  to  give  the  final 
word.  Dr.  Brown  went  down,  hoping  that  at 
least  half  a dozen  of  the  women  would  be 
there.  Not  a single  Dhai  turned  up!  Afraid 
to  break  away  from  “custom.”  Another  day 
appointed,  another  journey  down  in  the  heat, 
and  this  time  one  young  woman  dared.  She 
turned  out  afterward  to  be  almost,  if  not 
quite,  the  brightest  one  in  the  class.  She  went 
away  after  the  lesson  with  the  silver  piece 
in  her  hand.  Next  day  two  more  came,  and 
then  they  poured  in,  till  we  had  fifteen 
women.  We  woke  to  find  ourselves  popular 
with  the  Hereditary  Dhai.  We  had  to  limit 
the  class  when  the  fifteenth  had  come,  for 
they  were  such  a noisy,  inattentive  lot.  It  was 
not  midwifery  they  were  so  keen  to  learn,  but 
to  have  a harmless  hour  of  fun  and  the  pay. 
The  joking  and  the  laughter  and  general 
pandemonium,  with  nothing  serious  doing, 
characterized  those  first  days,  but  patience  and 
some  artful  measures  for  securing  interest 
won  out. 

Two  chief  aims  were  uppermost  in  our 
minds : to  teach  them  cleanliness,  and  how  to 
recognize  a difficulty  they  could  not  manage. 
Cleanliness  first.  How  to  get  the  idea  of  a 
germ  into  a Panjabi  woman’s  mind!  We  hit 
upon  the  device  of  taking  down  a magnifying 


glass  for  them  to  play  with,  and  it  was  a 
masterly  stroke.  They  passed  this  acceptable 
plaything  from  hand  to  hand,  examining 
everything,  and  then  they  listened  while  it  was 
explained  that  stronger  and  stronger  lenses 
showed  smaller  and  smaller  objects,  till  things 
not  seen  by  the  eye  alone  could  be  seen  with 
the  glass.  We  had  also  a colored  chart,  with 
pictures  of  some  dozens  of  germs,  and  among 
them  the  easily-remembered  tack-headed 
bacillus  of  lock-jaw,  a disease  which  they 
often  see  after  confinement.  From  this  we 
passed  to  the  necessity  of  clean  hands  and  the 
use  of  antiseptics,  and  the  idea  seemed  really 
in,  and  what  was  more,  their  attention  had 
been  gained.  They  listened  now,  and  the 
smarter  ones,  who  really  began  to  want  to 
learn,  often  grew  impatient  with  the  others, 
who  still  kept  up  their  noisy  fun. 

Real  progress  was  being  made.  Of  course, 
they  had  a big  foundation,  in  a way,  to  build 
upon,  a large  practice,  and  enough  normal 
cases,  in  spite  of  their  ignorance  and  dreadful 
ways  of  managing,  to  make  them  familiar 
with  a certain  number  of  the  commonest  facts. 
What  was  needed  was  to  classify  and  clarify 
their  worth-while  knowledge,  and  make  things 
hang  together  for  them,  and  elucidate  what 
lay  behind  outward  manifestations.  We  must 
needs  give  them  a revelation  or  two  as  to 
anatomy  and  nature’s  methods.  The  pelvic 
bone  was  to  them  an  undreamt-of  factor  in 


the  birth  process.  Babies  survived  or  perished 
because  fate  decreed  it  so,  not  because  a bone’s 
shape  ever  made  any  difference. 

I had  the  particular  enjoyment  of  teaching 
this  class  for  three  weeks  in  Dr.  Brown’s  ab- 
sence, a three  weeks’  experience  I would  not 
exchange  for  any  like  period  of  time  while  I 
was  in  India.  Soberness  and  some  zeal  for 
learning  had  taken  the  place  of  the  early  pan- 
demonium, and  I shall  never  forget  the  day 
when  I first  brought  out  the  manikin.  They 
were  ready  for  a new  “revelation.”  When  the 
manikin  was  taken  from  its  case  and  the  little 
chamois  skin  baby  was  put  through  the  move- 
ments of  birth,  there  was  an  absolute  silence 
in  the  room.  Every  eye  was  riveted  on  the 
matter  in  hand.  You  might  have  heard  a pin 
drop.  Here  was  a further  glimpse  of  nature’s 
method  and  system.  They  could  hardly  wait 
their  turn  to  show  that  they  could  do  the 
demonstration. 

And  so  on  to  the  end  of  the  short  three 
months’  course.  Each  Dhai  was  required  to 
demonstrate  twenty-five  cases  before  she  could 
go  up  for  her  examination  to  the  Civil  Sur- 
geon. She  had  to  take  some  one  of  us  with 
her  to  see  her  do  it  according  to  our  ways, 
and  we  helped  our  own  work  here  especially 
by  getting  her  as  often  as  possible  to  take  our 
students  to  cases  in  order  to  help  them  get 
the  required  number  which  they  each  had  to 
attend  before  they  could  be  said  to  have  com- 

9 


pleted  their  obstetrical  course.  When  the 
Dhais  went  up  for  their  tests,  all  but  twTo  or 
three  of  them  passed.  We  had  counted  on  the 
failure  of  some,  for  whilst  most  of  them  were 
young,  there  were  some  who  were  not,  but 
who  were  recognized  as  the  real  aristocrats 
of  the  profession,  and  they  served  to  give  a 
tone  to  the  class. 

Our  mid-wifery  practice  up  to  this  time  had 
amounted  to  almost  nothing.  The  number  of 
cases  in  a year  was  insignificant,  considering 
the  size  of  our  city  and  the  populousness  of 
the  surrounding  district;  perhaps  less  than  a 
hundred  cases,  all  told.  A large  number  of 
them  were  abnormal,  including  the  worst  pro- 
cedures known  to  obstetrical  surgery.  In  the 
first  six  months,  after  we  got  hold  of  the 
Hereditary  Dhais,  our  practice  jumped  to  over 
four  hundred  cases.  And  this  included  some 
grave  difficulties  recognized  by  the  mid-wife 
herself,  and  brought  to  us  before  it  was  too 
late.  The  first  Caesarian  Section  from  the 
city  was  brought  in  by  one  of  our  newly- 
trained  women,  and  mother  and  baby  both 
lived.  We  had  had  similar  cases  from  the 
villages,  but  never  from  our  own  city.  To 
celebrate  the  event,  a Persian  poem  was 
written  by  one  of  the  gentlemen  of  the  town, 
and  poem  and  baby  and  mother  were  all  ex- 
hibited at  our  next  fete. 

The  subsequent  history  of  the  mid-wifery 
classes  was  not  one  of  uneventful  smoothness. 


Possibly  because  of  the  jealousy  of  the  older 
“practitioners”  and  their  secret  connivance  to 
keep  younger  and  less  hostile  women  from 
attending,  it  became  increasingly  difficult  to 
get  and  hold  the  women.  We  never  could  put 
our  fingers  exactly  on  the  difficulty.  We  grew 
very  unpopular. 

However,  in  1911,  the  “city  fathers”  them- 
selves undertook  to  require  every  Dhai  in  the 
city  to  receive  instruction,  and  orders  were 
issued,  accordingly,  for  them  all  to  register  at 
the  Hospital  for  the  class  work.  A bewildered 
number  of  elderly  bodies  came  those  first  days 
of  the  compulsion,  protesting  that  they  did  not 
know  why  they  had  to  come  and  give  in  their 
names.  Slowly  the  teaching  got  to  be  more 
satisfactory  again.  The  women  came  to  us 
instead  of  our  having  to  go  to  them,  and 
examinations  and  certificates  are  now  regularly 
and  satisfactorily  given.  Often  mother-in-law 
and  daughter-in-law  are  in  the  same  class,  the 
older  women  bringing  the  younger — a very 
hopeful  feature. 

May  the  day  not  be  far  distant  when  every 
woman  aspiring  to  practice  mid-wifery  in 
Ludhiana  will  be  regarded  by  her  colleagues 
as  qualified  only  if  she  has  had  “the  Miss 
Sahib’s  training,’”  and  when  her  patronage  by 
the  city  women  will  depend  upon  her  being 
one  of  the  “Miss  Sahib’s  Dhais !” 

August,  1919. 


Price,  3 cents  each;  30  cents  per  dozen. 


